<div id="main_box">
	<div style="tex-align: center; width:100%; color: red;">
    						<?php if(count($error) != 0): ?>
                            <?php foreach($error as $e): ?>
                            <li><?php echo $e ?></li>
                            <?php endforeach; ?>
                            <?php endif; ?>
    </div>
	<form id="myfrom" onsubmit="return cyeucau();" name="fr" method="post" action="/buy_sim/success_required">
    
		<div class="h"> Đặt mua sim</div>
		<div class="b">
			<table class="style1" cellspacing="0" cellpadding="0" style="width: 100%; ">
				<tr>				
					<td style="height: 23px; width: 30%; background-color: #FFFFFF; text-align: left;">
						<p style="padding-top: 5px; padding-right: 10px; padding-bottom: 5px; padding-left: 10px;">Số 
						Sim: </p>
					</td>
					<td style="width: 50%; height: 23px; background-color: #FFFFFF; text-align: left;">
						<p style="padding-top: 5px; padding-right: 10px; padding-bottom: 5px; padding-left: 10px;">
						<input type="text" id="c0" style="width: 130px" name="sosim" onkeyup="checkmobis(this);"></p>
						<p style="padding-top: 0px; padding-right: 10px; padding-bottom: 5px; padding-left: 10px;">
						VD: sim 10 số đuôi 1989 nhập 09*1989</p>
						<p style="padding-top: 0x; padding-right: 10px; padding-bottom: 5px; padding-left: 10px;">
						Hoặc *1989 cho cả 10 và 11 số</p>
					</td>
				</tr>
				<tr>
					<td style="height: 23px; width: 30%; background-color: #FFFFFF; text-align: left;">
						<p style="padding-top: 5px; padding-right: 10px; padding-bottom: 5px; padding-left: 10px;">Thời 
						Hạn:</p>
					</td>
					<td style="width: 50%; height: 23px; background-color: #FFFFFF; text-align: left;">
						<p style="padding-top: 0px; padding-right: 10px; padding-bottom: 5px; padding-left: 10px;">
						<select id="c1" style="height: 22px; width: 135px;" name="ngayketthuc">
						<option value="15">15 Ngày</option>
						<option value="30">30 Ngày</option>
						<option value="60">60 Ngày</option>
						<option value="90">90 Ngày</option>
						<option selected="" value="180">6 Tháng</option>
						<option value="360">1 Năm</option>
						</select></p>
					</td>
				</tr>
				<tr>
					<td style="height: 23px; width: 30%; background-color: #FFFFFF; text-align: left;">
						<p style="padding-top: 5px; padding-right: 10px; padding-bottom: 5px; padding-left: 10px;">Số 
						Di Động:</p>
					</td>
					<td style="width: 50%; height: 23px; background-color: #FFFFFF; text-align: left;">
						<p style="padding-top: 0px; padding-right: 10px; padding-bottom: 5px; padding-left: 10px;">
						<input type="text" id="c2" style="width: 130px" name="mobile" onkeyup="checkmobis(this);"></p>
					</td>
				</tr>
				<tr>
					<td colspan="2" style="padding-top: 0px; padding-bottom: 0px; text-align: center; background-color: #FFFFFF">
						<input type="hidden" name="frmToken1" value="<?php echo $frmToken1; ?>"/>
						<strong><input type="submit" value="Gửi Yêu Cầu" name="submit"></strong>
					</td>
				</tr>
			</table>
		</div>
		<div class="c"></div>
    
    </form>
	</div>
</div>
</div>